By Shalinie Dowlatram
An estimated 85,000 people suffer from non-fatal gunshot wounds annually (Kaufman et al, 2020). It is difficult to grasp the burden of non-fatal firearm injuries due to the lack of availability of follow-up information on patient recovery. Unfortunately, population-based research on chronic pain caused by gunshot wounds is limited; however, numerous case studies give insight into the possible long-term effects of suffering from gunshot wounds and researchers advocate for further research.
Gunshot wounds to the upper extremities (arms, hands, and shoulders) were associated with a high incidence of total and partial nerve damage in a study that examined 17 patients (Ibrahim et al, 2022). Chronic pain was also associated with gunshot wounds to the upper extremities especially if the patient suffered from bone fractures (Ibrahim et al, 2022). Patients with gunshot wounds to the upper extremities are typically diagnosed with nerve damage months after their initial injury, and they usually need surgery to repair the nerve damage (Ibrahim et al, 2022).
A 2002 study that followed patients with non-fatal firearm-related injuries for eight months concluded that patients with injuries to their nervous system did not heal as well compared to patients with injuries to their abdomen and chest (Greenspan et al., 2002). Furthermore, the patients interviewed eight months after their initial firearm-related injury were still in a significant amount of pain, were struggling with their mental health, and were having difficulties coping with their injuries (Greenspan et al., 2002). The long-term health outcomes and chronic pain from firearm related injuries needs to be studied further to capture the full scope of the problem.
Unfortunately, many patients that suffer from gunshot wounds are left with bullets and bullet fragments embedded in their bodies (Nee et al., 2021). Bullets and bullet fragments that do not pose an immediate threat to the patient are usually not removed because removal may cause more bodily harm (Nee et al., 2021). While retained bullet fragments from non-fatal gunshot wounds are common, they are not without consequence. According to data from 2003 to 2012 obtained by Adult Blood Lead Epidemiology and Surveillance (ABLES), the CDC’s public health surveillance program that monitors lead poisoning in 41 different states, fewer than 1% of the people reported to suffer from lead toxicity had retained bullet fragments in their body (Weiss et al., 2017). Although it is rare for a patient with retained bullet fragments to suffer from lead poisoning, the consequences can be devastating. People with lead poisoning might experience numerous adverse health outcomes, including forgetfulness, abdominal pain, irritability, nausea, poor reproductive health, hypertension, etc. (Lead: Health problems caused by lead 2021). Lead poisoning from retained bullet fragments may be underestimated due to undiagnosed cases since not all states report to ABLES, nor are all patients with retained bullet fragments routinely tested for lead poisoning. Furthermore, reporting requirements for lead poisoning differ among states and they may have failed to determine to the source of lead poisoning for some patients (Weiss et al., 2017).
The pain from gun violence does not stop with nerve damage or lead poisoning from retained bullet fragments; it affects mental well-being. A study published in the Annals of Surgery concluded after conducting a systemic review of cases studies from 1995 to 2020 that approximately 49-60% of people with a firearm-related injury suffer from post-traumatic stress disorder (PTSD) (Orlas et al., 2021). Many gun violence survivors have described the horrors they encounter daily as they relive the events that left them permanently in pain. A podcast called Aftermath details the personal accounts of gun violence survivors and the difficulties they face while coping with physical limitations and psychological trauma due to their firearm-related injuries (Kohrman, 2022). One survivor who gave an account of his experience after suffering from a gunshot wound described his depression, nightmares, and triggers (like the sound of a balloon popping in a public place. While his symptoms have lessened overtime, he still experiences flashbacks from certain triggers, such as news coverage of active shooter drills in schools (Kohrman, 2022). This experience is unfortunately not unique to him, as numerous survivors of gun violence report similar experiences.
The pain from gun violence is pervasive and it invades every aspect of life. It is imperative that the long-term health outcomes from firearm-related injuries be further studied.
Centers for Disease Control and Prevention. (2021, December 8). Lead: Health problems caused by lead. Centers for Disease Control and Prevention. Retrieved October 8, 2022, from https://www.cdc.gov/niosh/topics/lead/health.html
Greenspan, A. I. & Kellermann, A. L. (2002). Physical and Psychological Outcomes 8 Months after Serious Gunshot Injury. The Journal of Trauma: Injury, Infection, and Critical Care, 53 (4), 709-716.
Kaufman EJ, Wiebe DJ, Xiong RA, Morrison CN, Seamon MJ, Delgado MK. Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017. JAMA Intern Med. 2021;181(2):237–244. Retrieved September 1, 2022, from doi:10.1001/jamainternmed.2020.6696
Kohrman, M. (2022, September 2). Aftermath, episode 8: ‘it stays with you’. The Trace. Retrieved October 9, 2022, from https://www.thetrace.org/2018/07/aftermath-podcast-school-shooting-hollan-holm/
Ibrahim, J., Hoffman, R. A., Silva, S., & Criner-Woozley, K. (2022). Incidence of Nerve Transection in Upper Extremity Gunshot Wounds. Bulletin of the Hospital for Joint Disease (2013), 80(2), 224–227.
Nee, N., Inaba, K., Schellenberg, M., Benjamin, E. R., Lam, L., Matsushima, K., Strumwasser, A. M., & Demetriades, D. (2021). Retained bullet fragments after nonfatal gunshot wounds: epidemiology and outcomes. The journal of trauma and acute care surgery, 90(6), 973–979. https://doi.org/10.1097/TA.0000000000003089
Orlas, C. P., Thomas, A., Herrera-Escobar, J. P., Price, M. A., Haider, A. H., Bulger, E. M., & National Trauma Research Action Plan (NTRAP) Investigators Group (2021). Long-term Outcomes of Firearm Injury Survivors in the United States: The National Trauma Research Action Plan Scoping Review. Annals of surgery, 274(6), 962–970. https://doi.org/10.1097/SLA.0000000000005204
Vella, M. A., Warshauer, A., Tortorello, G., Fernandez-Moure, J., Giacolone, J., Chen, B., Cabulong, A., Chreiman, K., Sims, C., Schwab, C. W., Reilly, P. M., Lane-Fall, M., & Seamon, M. J. (2020). Long-term functional, psychological, emotional, and social outcomes in survivors of firearm injuries. JAMA Surgery, 155(1), 51. https://doi.org/10.1001/jamasurg.2019.4533
Weiss, D., Tomasallo, C. D., Meiman, J., Alarcon, W., Graber, N. M., Bisgard, K. M., & Anderson, H. A. (2017, August 1). Elevated blood lead levels associated with retained bullet fragments – United States, 2003–2012. Centers for Disease Control and Prevention. Retrieved October 7, 2022, from https://www.cdc.gov/mmwr/volumes/66/wr/mm6605a2.htm